103808465-6-29-2021-04-CC-ASLR-C4FU9S-20210629152337

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 103808465
Report Date: 06/29/2021
Date Signed: 06/29/2021 03:23:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME:	DERMER'S CREATIVE CARE		FACILITY NUMBER:	103808465
ADMINISTRATOR:	DERMER, ADAM		FACILITY TYPE:	830
ADDRESS:	321 W. HERNDON		TELEPHONE:	(559) 435-2901
CITY:	PINEDALE	STATE: CA	ZIP CODE:	93650
CAPACITY:	30	CENSUS: 15	DATE:	06/29/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Adam Dermer		TIME COMPLETED:	03:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 06/29/21, Licensing Program Analyst (LPA) Angelica Slaughter conducted an unannounced annual inspection for the infant license. LPA met with Owner/Director, Adam Dermer, and toured the facility, indoors and outdoors. There were no bodies of water, firearms and/or ammunition on the premises. Disinfectants, hazardous items and medications were inaccessible to children. No poisons were observed during the inspection. Furniture and equipment were in good condition, free of sharp, loose or pointed parts. Playground equipment was in safe condition, free of sharp, loose or pointed parts. The surface of the outdoor activity space was maintained in a safe condition and was free of hazards. Areas around high climbing equipment and slides have cushioning material to absorb falls. Children's diaper changing facilities were sanitary, in good operating condition and near a sink as required by CCLD regulation. Floors in the facility were clean and safe. All kitchen, food preparation and storage areas were clean and free of litter/rubbish. The facility was free of flies, insects, and rodents/vermin. All food was protected against contamination and any contaminated food is discarded immediately. Solid waste storage containers had tight-fitting covers and were in good repair. Menus are posted at least one week in advance where an authorized representative can view them. Drinking water is available both indoors and outdoors. The facility had one or more functioning carbon monoxide detectors that meet statutory requirements. The facility had sufficient age appropriate furniture and equipment, including cribs, cots or mats, changing tables, and feeding chairs. Each crib, mat, or cot was occupied by only one infant at a time and cribs were free from all loose articles including blankets and pillows. There were no objects hanging above or attached to the crib. Infants are not swaddled in care. Staff physically check on sleeping infants every 15 minutes and documents any signs of distress which include but is not limited to: flushed skin color, increase in body temperature, restlessness, and labored breathing. For infants up to 12 months, documentation also includes sleeping position if it is other than on their back. Individual Infant Sleeping Plans will be completed and in file for each infant up to 12 months of age. Infants up to 12 months of age are placed on their backs for sleeping. Staff-infant ratio requirements were being met while infants were sleeping. There was indoor and outdoor activity space for infants that was physically separate.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: DERMER'S CREATIVE CARE	FACILITY NUMBER: 103808465
	VISIT DATE: 06/29/2021

NARRATIVE

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Capacity and limitations as specified on the license are being maintained. The name of the child care center Director or fully qualified teacher(s) designated to act in the Director's absence has been reported to the Department. The facility maintains a ratio of one teacher supervising no more than 4 infants in care. All children are under supervision, including visual supervision, of a teacher at all times. The person who signs the child in/out of the facility shall use their full legal signature and record the time of day. A sample of children's files were reviewed and contained contact information for authorized representative and/or relatives or others who can assume responsibility for the child, medical assessment, individual feeding plan, and Infant Needs and Services Plan. LPA also reviewed a sample of staff files and observed files were complete with health screening, immunization records for influenza, pertussis, and measles and current documentation of completed Mandated Reporter Training. Staff records contained documentation of meeting qualification requirements. Currently all staff's CPR and pediatric First Aid Certification expired on 05/20/21.

Prior to working or volunteering in a licensed child care facility, all individuals subject to a criminal record review have received a criminal record clearance or exemption. Upon notification from the Department, the Licensee will comply and act immediately to terminate the employment of, remove from the facility or bar from entering the facility for any person it is deemed necessary while the Department considers granting or denying an exemption.

Operating hours are Monday through Friday 7:00 AM – 6:00 PM.

Incidental Medical Services (IMS) are not currently being provided. Director is aware that an IMS plan is required to be submitted to the Licensing Office if they provide any of these services. Information regarding Amercians with Disability Act (ADA) can be obtained by contacting US Department of Justice toll free ADA Information line at (800) 514-0301 (voice), (800) 514-0383 (TDD) and website link https://ww.ada.gov/chilqanda.htm.

LPA and Director discussed the Community Care Licensing website www.ccld.ca.gov which will provide access to Provider Information Notices (PINs), Quarterly Updates, COVID-19 Information and Resources, Mandated Reporter Training, Safe Sleep in Child Care, Lead Poisoning Facts, Forms and Regulations.

Per Title 22 of the California Code of Regulations, the following deficiency was found (see next page, 809 D):

Exit interview was conducted with Adam Dermer. LPA provided Director with a copy of the Facility Evaluation Report (LIC 809), appeal rights, and the Notice of Site Visit form (LIC 9213). The LIC 809 is required to remain in the facility for public review and the LIC 9213 is required to be posted for 30 days.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710

FACILITY NAME: DERMER'S CREATIVE CARE	FACILITY NUMBER: 103808465
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/27/2021 Section Cited	1 2 3 4 5 6 7	At least one person trained in CPR and Pediatric First Aid shall be present when children are at the facility or at offsite activities. This requirement was not met as evidenced by this inspection.
	8 9 10 11 12 13 14	Staff's CPR/1st Aid expired on 05/20/21. This posses a potential risk to the health, safety and/or personal rights of children in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7
	1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Diana deLeon	TELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Angelica Slaughter	TELEPHONE: (559) 341-3920
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC809 (FAS) - (06/04)

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